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:5, � - ad <br /> �Y��� CITY of ORONO <br /> ':�'t` .r,c'� �;���'�'x.��1:. <br /> �`�� ^e:�' +�a� :. <br /> �:�.. �''�,.ehaw �.r�, <br /> �r�" ' '� ' ' Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices <br /> • <br /> � - � � On the North Shore of Lake Minnetonka <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data", we would like to inform you that your request for a permit or <br /> Iicense from the City of Orono or any of its departments may require <br /> you to furnish certain private or confidential information. <br /> You are notified that: <br /> 1. The information you furnish wil.l be used to determine your <br /> qualification for the permit or Iicense requested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or Iicense. <br /> 3. The information may be shared with other IocaZ , state or <br /> federal. agencies to the extent necessary to process the permit or <br /> Iicense. <br /> 4. If your requested permit or Iicense requires CounciZ action <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6. Your full name is required to process this appl.icaticn or <br /> permit. <br /> ...� 1l� �-t�t <br /> First M Ie Last <br /> �-(� `�( (� i l�.l � V� A u1� <br /> Address <br /> Q�(� r�� �I n� � �� 3!— <br /> City State Zip <br /> ��/ � 0 ��L� <br /> Phone <br /> I understand my rights as stated above. <br /> i nature <br /> BU1LDl\G&ZONING—473-7357 • ADMINISTRATION&FI\ANCE—473-7358 • PUBLIC WORKS—473-7359 <br /> ASSESSIN G <br />